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Gender Healthcare Policy Map

FAIR’s Gender Policy Map is a resource of aggregated information affecting sex reassignment treatments for minors in the United States.

The map aims to educate the public about this quickly evolving area, which involves healthcare, education, and public policy. This information is not intended as legal or healthcare advice. As new information becomes available, FAIR aims to update this resource in a timely manner. If you have additional information or comments, please contact us at at [email protected].

As of March 2023, six states have banned sex reassignment treatments for minors through their state legislatures: Alabama (federal appeal), Arkansas (federal appeal), Mississippi, South Dakota, Tennessee, and Utah. Florida’s Medical Board made the practice illegal for licensed physicians.

Federal Regulations
Federal Courts
States
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Created with Raphaël 2.3.0 and Mapael (https://www.vincentbroute.fr/mapael/)

Last Updated: March 14, 2023

Federal Statutes and Regulations

Section 1557 of the Patient Protection and Affordable Care Act Adds Gender Identity as Protected Category
May 2016

The Affordable Care Act (ACA) passed in 2010. Later, Section 1557 underwent a rulemaking process (with a final rule published in 2016) adding gender identity as a federally mandated protected class, thereby requiring participating entities to provide medical care and insurance coverage. Litigation on this rule has been ongoing.
federalregister.gov
regulation
Proposed Regulation from the Department of Health and Human Services
August 2022

The Department of Health and Human Services (HHS) issued this proposed rule on Section 1557 of the Affordable Care Act (ACA). This rule reasserts the earlier 2016 effort (which is under litigation), again adding gender identity as a protected category and related medical treatment as covered under federal healthcare programs. Issued on August 4, 2022; currently not finalized.
govinfo.gov
Proposed Rule
FAIR Issues Letter Opposing the Section 1557 Expansion into Gender Identity
September 2022

During the open comment period for the proposed August 2022 regulation, the Foundation Against Intolerance & Racism submitted a letter expressing concern for healthcare providers’ freedoms of religion, conflict of conscience, and professional medical judgment.

FAIR urges the Department to amend the rule, and acknowledge the debate that exists within the medical community.
fairforall.org
Letter
FDA Warning for Puberty Blockers in Children
July 2022

The FDA issued a warning about the risk of pseudotumor cerebri, or brain swelling, when certain puberty blockers are used in children. The FDA reports 6 cases, 5 for the use in precocious puberty and one related to transgender care.
fda.gov
FDA Warning

Federal Lawsuits and Decisions

View Circuit Court map to see which states are affected by Circuit Court cases.

Franciscan Alliance Inc. v. Xavier Becerra
August 2022

The 5th Circuit Court of Appeals upheld a permanent injunction prohibiting the Department of Health and Human Services from requiring clinicians to provide services and insurance coverage for gender-transition procedures.
uscourts.gov
Ruling
Eknes-Tucker et al v. Governor of the State of Alabama
August 2022

Case litigating Alabama’s Vulnerable Child Protection and Compassion Act that was partially blocked and appealed to the 11th Circuit Court of Appeals. Oral arguments occurred on November 18, 2022.

FInal ruling is pending.
justice.gov
Lawsuit
The Religious Sisters of Mercy v. Xavier Becerra
December 2022

The 8th Circuit Court of Appeals upheld The Catholic Benefits Association’s right to abstain from providing transgender healthcare services that are in conflict with their religious beliefs.
uscourts.gov
Ruling

Alabama

Vulnerable Child Compassion and Protection Act
May 2022

The legislature passed this law making it a felony—punishable with up to 10 years in prison or a fine up to $15,000—to provide medical care to minors altering or "affirming" their gender, or for school personnel to hide information from parents.

Lawsuit then filed by the ACLU challenging the law in May 2022.
legiscan.com
Law
Eknes-Tucker et al v. Governor of the State of Alabama
May 2022

In this case, a family, backed by the ACLU, sued the State of Alabama in May 2022 in order to challenge the Vulnerable Child Compassion and Protection Act.

The court partially upheld the law, allowing hormones for minors while maintaining the ban on surgery. It also upheld the law’s ban on hiding information from parents.

Appealed in Aug 2022 to the 11th Circuit Court of Appeals.
casetext.com
Lawsuit

Arizona

Senate Bill 1138
March 2022

Law banning gender reassignment surgery for minors under 18 years old. Law takes effect March 31, 2023.

Signed by Arizona Governor Doug Doucy on March 30, 2022.
azleg.gov
Law

Arkansas

SB 199: Protecting Minors from Medical Malpractice Act 2023
Law extending malpractice liability for medical professionals engaged in sex reassignment treatments for minors.

The law goes into effect summer 2023.
state.ar.us
Law
Save Adolescents From Experimentation Act (SAFE)
Act 626 of 2021 - Law passed prohibiting physicians from providing “gender transition” treatments such as hormones, puberty blockers, and surgeries to minors under 18 years old.

The ACLU challenged this law in 2021. The law is currently blocked from enforcement due to an injunction and ongoing litigation.
state.ar.us
Law
Brandt et al v. Rutledge et al
August 2022

Families backed by the ACLU sued the State of Arkansas in Federal Court in May of 2021 to block the enactment of the SAFE ACT law.

The Federal court granted a preliminary injunction blocking enforcement of the law in July 2021, which was upheld by the 8th Circuit Court of Appeals in August 2022.

A trial on the merits of the law concluded in December 2022 in the US District Court for the Eastern District of Arkansas. The final decision is pending.
casetext.com
Lawsuit

California

SB107 - Gender-affirming Health Care Law
October 2022

Prohibits health care providers, law enforcement and courts in California from aiding in another state’s investigation related to a minor receiving sex reassignment treatments in California.
ca.gov
Law

Florida

Medicaid Coverage Determination
June 2022

The Florida Medical Board determined that medical transition for minors is experimental, and therefore not eligible for Medicaid coverage.
myflorida.com
Regulation
Medical Board Ruling
February 2022

Florida’s Board of Medicine and Osteopathic Board of Medicine finalized a rule in Feb 2022 determining that sex reassignment treatments for minors are illegal for licensed physicians in Florida. Minors being treated with hormones prior to the effective date may continue using the medications.

Effective March 16 2023.
flrules.org
Regulation

Illinois

HB4664 - Reproductive and Gender Affirming Health Care Bill
Law shielding sex reassignment health care patients and treatment providers from legal action initiated outside of Illinois, as well as action that includes parties both within and outside of Illinois, and requiring gender-affirming health care medications to be covered by insurers at no cost to the consumer.
ilga.gov
Law

Indiana

The Indiana legislature introduced multiple bills during the 2023 session related to sex reassignment treatments for minors, including HB 1589, HB 1569, HB 1407, SB480, HB 1525, HB 1232,HB 1231,HB 1220, HB 1118. We highlight HB 1118 below.
HB 1118
Prohibits medical and mental health clinicians in healthcare facilities or schools from engaging in interventions to alter a minor’s biological sex. Knowledge of such activities requires mandatory reporting to child services or police with provision for immunity. Clinicians may face misdemeanor and felony charges as well as potential disciplinary action against their license.

Effective July 1, 2023.
in.gov
Pending Law

Minnesota

Executive Order
23-03
March 2023

Reinforces sex reassignment treatments as “medically necessary” and covered by insurance, empowers agencies to investigate “unfair” practices, requires no assistance from state agencies for outside state actions, protects against extradition, and the Department of Health must submit a comprehensive report by Dec. 31, 2023 about the safety and efficacy of these treatments.
mn.gov
Executive Order

Mississippi

HB 1125 Regulate Experimental Adolescent Procedures (REAP) Act
February 2023

Prohibits gender transition medications and procedures for minors, including insurance coverage to pay for such services. Health care professionals are subject to licensure removal if they break the law.
ms.us
Law

Missouri

Attorney General Investigation
February 2023

Missouri Attorney General Andrew Bailey launched a multiagency investigation into the Pediatric Transgender Center at St. Louis Children’s Hospital to evaluate alleged patient harm, violations of professional conduct by licensed practitioners, and billing fraud. The investigation was triggered by a whistleblower at the Center.
mo.gov
Investigation

New York

Division of Human Rights - Guidance Document
New York's Division of Human Rights has published a document called "Guidance on Protections from Gender Identity Discrimination" under New York State's "Gender Expression Non-Discrimination Act" (GENDA) law. Issued on January 29, 2020.
ny.gov
Guidance

Ohio

Save Adolescents from Experimentation Act (SAFE)
House Bill 454 introduced October 19, 2021 “to prohibit certain procedures to alter a minor child's sex”.

The proposed bill is currently in the legislative process.
ohio.gov
Bill

Oklahoma

Senate Bill 3XX
October 3, 2022

Governor Kevin Stitt signed SB 3XX which blocks funding to prevent gender transition services for minors at Oklahoma Children’s Hospital at OU Health.
state.ok.us
Law
Senate Bill 613
Senate Bill 613 seeks to prohibit the use of medications and surgeries to treat minors with gender dysphoria for the purposes of changing their sex. Licensed healthcare practitioners will be subject to Medical Board investigation, civil and criminal penalties.
oklegislature.gov
Pending Law

South Dakota

House Bill 1080
February 2023

Bans hormones and medical procedures to alter the biological sex of minors. Medical professionals are subject to having their license revoked.
sdlegislature.gov
Law

Tennessee

General Assembly Bills HB0001/SB0001
March 2023

Law prohibiting a healthcare provider from performing on a minor or administering to a minor a medical procedure if the performance or administration of the procedure is for the purpose of enabling a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex.
capitol.tn.gov
Law

Texas

Attorney General Opinion
Opinion No. KP-040 - Attorney General Ken Paxton's advisory opinion in Feb 2022 to Texas legislature to include gender transition interventions under the legal definition of child abuse in Texas.
texasag.gov
AG Opinion
Letter from Governor Abbott
In February 2022, Gov. Greg Abbott sent a Letter to the Department of Family and Protective Services (DFPS) informing them that child gender transition activities fall under rules of mandatory reporting for child abuse to the state.
texas.gov
Letter
Doe vs. Abbott
Doe family sued Gov. Abbott, DFPS Commissioner, and DFPS over the rule to categorize medical treatments for youth gender dysphoria as child abuse and to investigate families.In March 2022, the 3rd Circut Court in Texas blocked the order, and in May 2022, the Texas Supreme Court upheld the lower court’s ruling to block the State from investigating families.
txcourts.gov
Lawsuit
Pflag vs. Abbott
Pflag and several families sued Gov. Abbott, DFPS Commissioner, and DFPS over the rule to categorize medical treatments for youth gender dysphoria as child abuse and to investigate families. The case is currently on appeal in the Third Circuit Court of Texas.
aclu.org
Lawsuit

Utah

S.B. 16 Transgender Medical Treatments and Procedures Amendments
January 2023

Bans medical service to change the sex of youth with gender dysphoria.
utah.gov
Law

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